Brushing only part of the solution for bad breath

Q. I have bad breath. I brush, floss and use mouthwash. What else can I do?

A. Bad breath, which also goes by the name halitosis, can be embarrassing. Lucky for you, there's a lot you can do.

Most bad breath starts with bacteria in the mouth. Bacteria live everywhere in the mouth. You already know to brush and floss your teeth daily. But it's just as important to brush your tongue every day, with toothpaste on the brush. Crazy as that may sound, it really helps.

Bacteria live on the tongue and release gases that smell bad. The area at the far back of the tongue is particularly important. Unfortunately, brushing that area tends to make a lot of people gag. If you're like that, just brush that part of the tongue in several different and brief strokes: First the right side, rest, then the middle, rest, then the left side.

When plaque collects under the gums, the bacteria in it release foul smells. If the plaque under the gums leads to infection of the gums, that also causes foul smells. Flossing daily to remove plaque from the gum pockets around the teeth can combat this problem.

Food particles that collect on poorly fitting or unclean dentures can also cause odor.

Certain foods have a strong association with breath odor. Garlic is a well-known culprit — garlic breath can last for up to three hours! Alcohol, too, can be detected on the breath long after it's been consumed.

Infection and chronic disease can also play a role. Kidney failure, liver disease, diabetes and respiratory tract infections can cause breath odor.

Too little moisture in the mouth allows dead cells and bacteria to accumulate on your tongue and teeth. Dry mouth is what causes “morning breath.” (Some people call it “dragon breath.”)

Smoking and chewing tobacco lend an unpleasant scent to your breath. They also contribute to dry mouth and gum disease, both of which cause bad breath.

Here are Doctor K's seven steps to eliminate bad breath:

Ÿ Brush and floss daily.

Ÿ Brush your tongue and use a tongue scraper if necessary.

Ÿ Rinse with plain water after meals if brushing isn't an option.

Ÿ Get regular dental checkups to catch and treat gum (periodontal) disease.

Ÿ Snack on sugar-free foods or chew gum sweetened with xylitol to clear away food particles and keep saliva flowing.

Ÿ Use an over-the-counter mouthwash containing zinc.

Ÿ Don't smoke.

We have more information on battling bad breath in our Special Health Report, “Dental Health for Adults: A Guide to Protecting Your Teeth and Gums.” You can find out more about it at my website.

Ÿ Dr. Komaroff is a physician and professor at Harvard Medical School. Send questions and get information: AskDoctorK.com.